State Department of Health Director Loretta Fuddy died of cardiac arrhythmia resulting from stress, following a plane crash in the ocean off Kalaupapa last month, police said.
The 65-year-old Fuddy was among nine people aboard the Makani Kai Air flight that had taken off from Kalaupapa and was headed for Honolulu when the airplane lost power at 3:37 p.m. Dec. 11.
The other passengers and the pilot survived after putting on life preservers and getting out of the plane. The Maui Fire Department and U.S. Coast Guard rescued the survivors and recovered Fuddy's body.
In a news release Monday, Maui police said it was determined that the cause of Fuddy's death was "cardiac arrhythmia as a result of stress." The death was accidental, police said.
The National Transportation Safety Board is investigating the crash.
After the crash, Fuddy was airlifted from the ocean, taken to Kalaupapa Airport and then transported by ambulance to a nearby care home.
The Rev. Pat Killilea, pastor of St. Francis Parish in Kalaupapa, reported that he prayed over her body and consoled her assistant, later identified as Deputy Health Director Keith Yamamoto.
Killilea said Fuddy was put in a floatation device in the water, and Yamamoto held her hand.
But, "at one stage she let go and didn't respond," Killilea said, adding that "at that point, I think (Yamamoto) knew she had passed."
Fuddy and Yamamoto had visited Kalaupapa and were on the flight to Honolulu after making an annual visit to the settlement where Hansen's disease patients were exiled until 1969. The Health Department still runs the facility, although only a few former patients live at Kalaupapa.
Pilot Clyde Kawasaki and a passenger who swam to shore have said Fuddy appeared fine while bobbing in the water after everyone exited the aircraft and waited for help. The NTSB's preliminary report said the single-engine plane floated for about 25 minutes before sinking.
Fuddy was healthy and didn't have any known heart problems, her brother, Lewis Fuddy, said Monday.
"She wasn't an anxious person," he said. "To be head of the Health Department, you have to have some cool nerves."
Knowing the cause of death doesn't alleviate her family's grief at her loss, he said.
"I don't think it's ever going to bring any comfort to us," he said. "We felt she had a lot of years to live and only the Lord knows why."
* The Associated Press contributed to this report.